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Abstract:
A 68-year-old male presented to his primary care physician for evaluation of worsening headaches. He reported a 3-month history of daily, progressively worsening right-sided retro-orbital headaches that were becoming increasingly intolerable.
Headaches were associated with nausea, photophobia, and increasingly blurry vision. Blurry vision was most noticeable in the right temporal visual field and caused him to have difficulty with depth perception.
He also described a 16-month history of low libido, loss of axillary and chest hair, decreased testicular volume, and gynecomastia, for which he has been receiving testosterone injections. His low libido was worsening and accompanied by symptoms of alternating hot and cold intolerance, tremulousness, and unintentional weight loss. He also described alternating hot and cold intolerance, tremulousness, and unintentional weight loss.
Discussion
Please use the discussion feature below to ask the authors your questions and provide further feedback on others’ questions. All questions and replies are moderated.
From the history ,the picture directed us to pituitary pathology
We might ask for
ophthalmological consultantion
Hormonal study workup
Ctscan
MRI
WITH CONTRAST
I agree with all of the above! Prior to an ophthalmological consultation, would you do an eye exam yourself? Perhaps you could avoid the consult if you can explain the symptoms with the other tests you mentioned.
Needs to do CT scan and MRI nose, para-nasal sinuses, and brain +/- contrast .
Q. Pituitary gland tumor.
Yes, the pituitary gland is an important structure localized by his symptoms. Would you choose to get an MRI pituitary after the preliminary imaging you suggested? Thank you for participating!
Are there any nasal or sinus type symptoms? Sounds like a pituitary gland might be having problems. Time to get a CT or MRI scan.
There were no symptoms of rhinorrhea, congestion, or other sinus symptoms. You are right, though, pituitary imaging will be necessary!